The proportion of women who marry late and have children late in life is high in China, and many young patients develop breast cancer before they have children. It is essential to protect ovarian function in this group of patients so that they can be treated for breast cancer while preserving their reproductive function as much as possible. Chemotherapy damages mature follicle cells and inhibits the formation of primordial follicles and ovarian follicles, causing irreversible damage to ovarian function, affecting the menstrual cycle and even leading to early ovarian failure. In foreign countries, patients with fertility requirements are usually routinely consulted with obstetrics and gynecology for oocyte freezing before chemotherapy; however, this freezing technique is rarely used in China for various reasons. The PROMISE trial found that combining GnRHa with adjuvant CMF chemotherapy significantly reduced the incidence of amenorrhea in young patients by 17% compared to CMF alone, and increased the rate of return of menstruation after treatment. In the recent POEMS study, on the other hand, 257 premenopausal receptor-negative patients were randomized to chemotherapy alone or chemotherapy combined with GnRHa to assess their ovarian function. Ultimately, 218 patients were available for pregnancy and prognosis assessment, and 135 patients were available for ovarian function assessment. The results suggested that administration of GnRHa in conjunction with chemotherapy significantly reduced the incidence of 2-year ovarian failure (8% in the combination group versus 22% in the chemotherapy alone group; OR=0.30, P=0.04) and that more women achieved pregnancy and safe delivery (21% versus 11%; P=0.03). in 2015, the St. Gallen Global Panel of Experts voted that 78.9% of experts supported that hormone receptor-negative young breast cancer patients should receive chemotherapy with the addition of ovarian function suppression for fertility protection. These studies give hope for the protection of ovarian function and successful pregnancy after treatment in young patients.
In view of the fact that the assessment and protection of ovarian function is not yet fully popular and widespread in China, the group discussed and reached the following consensus on this area. For hormone receptor-negative early-stage breast cancer patients who wish to become pregnant, GnRHa can be given concurrently with adjuvant chemotherapy to reduce the incidence of 2-year ovarian failure and increase the likelihood of subsequent pregnancy. For young hormone receptor-positive patients who have a strong desire to have children during adjuvant endocrine therapy, factors such as the patient’s degree of disease risk, disease-free interval and the patient’s age need to be taken into account. Some intermediate and low-risk patients may suspend endocrine therapy and attempt pregnancy after 2-3 years of endocrine therapy and continue to receive complete endocrine therapy after pregnancy.